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1. REGIONAL
ANESTHESIA
Dr Nisar Ahmed Arain
Assistant Professor
Anesthesia/Critical Care/ER

2. -DEFINATION Any technique to induce the
absence of sensation in pert of the body is
Regional Anesthesia

3. -Why one choose
-REGIONAL ANESTHESIA
--It is cheap
--It gives high patients satisfaction
--It maintains patent airway
--Blood loss is too less
--It gives selective Muscle relaxation
There is Decreased incidence of DVT and PE

4. It is because of the following
--Hypotension
--Risk of toxicity
--Many patients wants to be asleep
during surgery
--Skills are required
--Patients can talk
--Patients may get Anxiety
--It is not reliable for surgery extending
more then 2> hours
-Why avoiding
-REGIONAL ANESTHESIA

5. -Different Types of
-REGIONAL ANESTHESIA
--Topical
--Intravenous (Bier’s Block)
--Peripheral Nerve Block
--Plexus Block
a-Brachial
b-Lumber
--Neuro-Axial Block

6. --It provides anesthesia for a surgical
procedure
--It provides Analgesia post-operatively
or during Labor and Delivery
--Therapy for patients with
a-Chronic Pain
b-Syndromes
c-Cancer
-USES OF
-REGIONAL ANESTHESIA

7. -Spread of Local anesthetic Drugs
-This depends on the following factors
--Baricity of Local Anesthetic
--Concentration of Local Anesthetic
--Position of the patient
--Volume of drug injected
--Level of injection given
--Speed of injection given

8. -Neuro-Axial Blocks
--Spinal Block
--Epidural Block
--Caudal Block

9. -Neuro-Axial Blocks

10. -Spinal and Epidural Anesthesia
--Local Anesthetic Injection
given into the
a-Subarachnoid or
b-Epidural space
--Patients position
a-Sitting or
b-Lateral
--Approach
a-Midline or
b-Para-Median
--Heavy Marcaine

11. -NEEDLES --Needles differ according to their bevel.
--Bevel may be blunt edge, or sharp edge
--They may be of Short, Medium or Long length
we have “Tuohy’s needle” used for epidural

12. -EPIDURAL ANESTHESIA

13. -TECHNIQUE
METHOD
--Single dose injection
--Fractional – continuous Epidural
Repeated injections of LA although
Catheter is inserted into the
Epidural space
POSITION
--Cervical Epidural – sitting position (C7)
--Thoracic Epidural – (T7)
--Lumber Epidural (L1/L2—L2/L3—L3/L4—L4/L5)

14. -SPINAL ANESTHESIA

15. -SPINAL ANESTHESIA
1

16. -SPINAL ANESTHESIA / EPIDURAL ANESTHESIA

17. -PRE PROCEDURE PREPARATION
--FOLLOWING SHOULD BE
OBSERVED CAREFULLY
--Patients assesment
--Explain the procedure and take consent of the
patient
--Care about patient’s Fasting
--Equipment for resuscitation and giving GA
should be ready
--1/2 I/V lines should be inserted and maintained
--Ensure ASEPSIS in whole procedure

18. -ANATOMICAL DETAILS OF THE PROCEDURE

19. -ANATOMICAL DETAILS OF THE PROCEDURE

20. -ANATOMICAL DETAILS OF THE PROCEDURE

21. -ABSOLUTE CONTRA-INDICATIONS
--Patients Refusal
--Coagulopathy
--Skin infection at the site
of needle insertion
--Increased ICP
--Hypovolemia

22. -RELATIVE CONTRAINDICATIONS
--Un co-operative patient
--Pre-existing Neurological disorder
--Fixed Cardiac output status
(AS, MS, HOMC, 3rd degree block
--Anatomical abnormalities
--Prophylactic low dose Heparin use

23. -COMPLICATIONS of
-EPIDURAL ANESTHESIA
--1-Anaphylaxis
--2-Pain
--3-Post-Spinal Headache
--4-Hypotension and Bradycardia
--5-Hypothermia
--6Nerve Damage
--7-Respiratory Failure
--8-Epidural or Intrathecal Bleed
--9-Spinal cord Hematoma
--10-Infection
--11-Urinary Retention

24. -BIERS BLOCK
--Intravenous regional Anesthesia
--August Bier, 1908
--Modern Version, 1963’s by Holmes
--Rapid and reasonable muscle
relaxation
--This procedure is indicated in only
two conditions
a-Surgical Procedures in the Arm
below the Elbow or leg below the
knee
b-Better if procedures are
completed within 40—60 mins

25. -PROCEDURE
--EXSENGUINATION
a-Gravity or compression with bandage
--TOURNIQUET
a-Pneumatic cuff to 250 mm Hg in Arm or 50 mm
Hg > SBP
--MEDICINE
a-The Choice of Drug is “Prilocaine”
It is least toxic with largest TI.
b-If not available then Lidocaine is an acceptable
alternative
c-In the Arm Dosage can be 30 – 40 ml of 0.5%
Prilocaine or 0.5% of Lidocaine
d-In Leg, larger volumes 50 – 60 ml would be required
--PROCEDURE
a-May start after 3 – 6 minutes

26. -POST PROCEDURE CARE
--Deflate this Cuff for few seconds
--Re-Inflate for a minute
--Rinse, Lather and Repeat
--Observe for 15 Minutes
--Discharge
--By no means Tourniquet should be
Deflated until atleast 20 minutes
after giving injection

27. -Advantages of Bier’s block
--No need for NPO status
--Patient is completely awake during the
procedure
--Shorter post procedural observation time

28. --Lose Pulse
--Possible superficial nerve
damage
--Unable to splint or cast with
tourniquet inflated
-Dis Advantages of “Bier’s Block”

29. -Adverse Events of Bier’s Block
--Tourniquet Pain
--At intravenous site blotchy erythema
--Flushing, or Urticaria
--Dizziness, Metallic taste in the mouth and
tingling
--Tourniquet Fails / Lidocaine bolus may
cause
a-Headache
b-Lethargy
c-Slurred speech
d-Seizure
--Hypotension, Bradycardia

30. --If tourniquet cannot be safely used
--Sickle cell disease (Homozygous) or
Reynaud’s
--Shock
--Multiple Trauma (Crush injuries of
relevant limb)
--Hypersensitivity to Prilocaine or Lidocaine
--Seizer disorder
--CONTRA INDICATIONS OF
BIERS BLOCK

31. -CONTROVERSIES OF
BIERS BLOCK
--Dose of Lidocaine
--Volume of Lidocaine Infusion
--Other Medical Problems
a-Instead of Lidocaine what to use ?
b-In addition to Lidocaine what to use ?

32. --Closed fractures
--Burn Debridement
--Removal of ground-in debris
--Abscess incision and drainage
--Laceration repair
--Foreign body removal
--Limited or short surgical procedures
-INDIATIONS OF
BIERS BLOCK

33. THANK YOU